{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,26]],"date-time":"2026-05-26T14:13:45Z","timestamp":1779804825865,"version":"3.53.1"},"reference-count":45,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2026,5,26]],"date-time":"2026-05-26T00:00:00Z","timestamp":1779753600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Ministry of Science of the Republic of Serbia","award":["451-03-34\/2026-03\/200110"],"award-info":[{"award-number":["451-03-34\/2026-03\/200110"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JFMK"],"abstract":"<jats:p>Background: Reports on subchondral bone mechano-structure in individuals with various stages of knee osteoarthritis (KOA) are limited and often conflicting in contemporary literature. Our study aimed to assess differences in subchondral trabecular bone mechano-structure across late KOA stages in a homogenous group of patients with varus malalignment (confirmed by negative hip-knee-ankle-angle values). Methods: This retrospective cross-sectional study included micro-computed tomography scanning and Vickers micro-hardness testing of 90 bone samples (30 femoral and 60 tibial) collected from 15 adult patients with primary KOA undergoing total knee arthroplasty (TKA). The Kellgren\u2013Lawrence grading system was used to assess the severity of KOA lesions in the included individuals, and bone samples were divided into the following groups: moderate KOA (42 samples from seven patients, age: 70 \u00b1 7 years, females: 3\/7) and end-stage KOA (48 samples from eight patients, age: 70 \u00b1 6 years, females: 5\/8). Results: Our data revealed site-specific sclerotic alterations in subchondral trabecular bone mechano-structure (thicker trabeculae, coupled with higher bone mineral content and increased bone micro-hardness) in individuals with end-stage KOA compared to moderate KOA, supporting its role in KOA pathogenesis beyond the exclusive cartilage degeneration effect. Our data also revealed that most heterogeneous subchondral trabecular mechano-structure was present in bone samples obtained from the medial part of the tibial and femoral condyle, revealing the substantial effect of mechanical loading during varus knee malalignment. Conclusions: Observed site-specific alterations in subchondral bone mechano-structure in individuals with end-stage KOA supported the role of subchondral sclerosis in primary KOA pathogenesis beyond its exclusive effect on cartilage degeneration.<\/jats:p>","DOI":"10.3390\/jfmk11020210","type":"journal-article","created":{"date-parts":[[2026,5,26]],"date-time":"2026-05-26T13:28:21Z","timestamp":1779802101000},"page":"210","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Stage-Dependent Changes in Subchondral Trabecular Bone Mechano-Structure in Primary Knee Osteoarthritis with Varus Malalignment"],"prefix":"10.3390","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-9109-1197","authenticated-orcid":false,"given":"Andreja","family":"Baljozovic","sequence":"first","affiliation":[{"name":"Institute of Orthopedics Banjica, Faculty of Medicine, University of Belgrade, Mihaila Avramovica 28, 11000 Belgrade, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Uros","family":"Andjelic","sequence":"additional","affiliation":[{"name":"Center of Bone Biology, Faculty of Medicine, University of Belgrade, Dr. Subotica 4\/2, 11000 Belgrade, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marko","family":"Vujacic","sequence":"additional","affiliation":[{"name":"Institute of Orthopedics Banjica, Faculty of Medicine, University of Belgrade, Mihaila Avramovica 28, 11000 Belgrade, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marko","family":"Dimitrijevic","sequence":"additional","affiliation":[{"name":"Institute of Orthopedics Banjica, Faculty of Medicine, University of Belgrade, Mihaila Avramovica 28, 11000 Belgrade, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Danijela","family":"Djonic","sequence":"additional","affiliation":[{"name":"Center of Bone Biology, Faculty of Medicine, University of Belgrade, Dr. Subotica 4\/2, 11000 Belgrade, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zoran","family":"Bascarevic","sequence":"additional","affiliation":[{"name":"Institute of Orthopedics Banjica, Faculty of Medicine, University of Belgrade, Mihaila Avramovica 28, 11000 Belgrade, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3124-1400","authenticated-orcid":false,"given":"Jelena","family":"Jadzic","sequence":"additional","affiliation":[{"name":"Center of Bone Biology, Faculty of Medicine, University of Belgrade, Dr. Subotica 4\/2, 11000 Belgrade, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,5,26]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"115155","DOI":"10.1016\/j.bone.2019.115155","article-title":"In Vivo Analysis of Subchondral Trabecular Bone in Patients with Osteoarthritis of the Knee Using Second-Generation High-Resolution Peripheral Quantitative Computed Tomography (HR-PQCT)","volume":"132","author":"Shiraishi","year":"2020","journal-title":"Bone"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"766","DOI":"10.1186\/s13018-025-06140-0","article-title":"Global, Regional, and National Burden of Knee Osteoarthritis: Findings from the Global Burden of Disease Study 2021 and Projections to 2045","volume":"20","author":"Ouyang","year":"2025","journal-title":"J. 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